OP0248 SEVERE COVID-19 OUTCOMES AMONG PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES: A POPULATION-BASED STUDY
Authors: S. Marozoff, Z. A. Fazal, J. Tan, N. Lu, A. Hoens, D. Lacaille, J. Kopec, H. Xie, J. M. Loree, J. Esdaile, J. A. Aviña-Zubieta
Journal: Annals of the Rheumatic Diseases (2022)

Background Individuals with autoimmune rheumatic diseases (ARDs) may be at greater risk of severe COVID-19 outcomes than individuals in the general population. Objectives This study assesses the risk of COVID-19-related hospitalization, intensive care unit (ICU) admission, and COVID-19-specific mortality in patients with ARDs compared to matched general population comparators. Methods We conducted a population-based cohort study, using administrative datasets from British Columbia, Canada (February 2020-August 2021). Among all test-positive SARS-CoV-2 adults, we used ICD codes to identify all individuals with an ARD : rheumatoid arthritis (RA), psoriasis/psoriatic arthritis (PsO/PsA), ankylosing spondylitis (AS), and systemic autoimmune rheumatic diseases (SARDs), including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis, myositis, and adult systemic vasculitides. Individuals with an ARD were matched 1:5 to general population test-positive SARS-CoV-2 individuals on age (± 5 years), sex, month/year of initial positive SARS-CoV-2 test, and health authority. Conditional logistic regression models adjusting for socioeconomic status, Charlson comorbidity index, hypertension, rural address, and number of previous COVID-19 PCR tests were performed to assess risk of COVID-19-related hospitalizations, ICU admissions, and COVID-19-specific mortality (mortality with primary ICD code for COVID-19). Results The risk of COVID-19-related hospitalization was significantly increased for patients with ARDs overall (aOR: 1.30) (Table 1). Within ARDs, the patient group at greatest risk of hospitalization was adult systemic vasculitides (aOR: 2.18). The risk of ICU admission was significantly increased for patients with ARDs overall (aOR: 1.30). Within ARDs, the patient group at greatest risk of ICU admission was those with AS (aOR: 2.03). The risk of COVID-19-specific mortality was significantly increased for patients with ARDs overall (aOR: 1.24). Within ARDs, the patient group at greatest risk of COVID-19-specific mortality was those with AS (aOR: 2.15). Table 1. Risk of severe COVID-19 outcomes among patients with ARDs Hospitalizations ICU admissions COVID-19-specific mortality n (%) aOR (95% CI) n (%) aOR (95% CI) n (%) aOR (95% CI) ARDs (6,279 ) 780 (12.4) 1.30 (1.19, 1.43 ) 225 (3.6) 1.30 (1.11, 1.51 ) 229 (3.7) 1.24 (1.05, 1.47 ) ARD comparators (31,130) 2,843 (9.1) 1.00 807 (2.6) 1.00 847 (2.7) 1.00 RA (2,067 ) 321 (15.5) 1.34 (1.15, 1.54 ) 95 (4.6) 1.30 (1.03, 1.65 ) 103 (5.0) 1.18 (0.92, 1.52) RA comparators (10,197 ) 1,151 (11.3) 1.00 336 (3.3) 1.00 400 (3.9) 1.00 PsO/PsA (2,695 ) 263 (9.8) 1.17 (1.01, 1.37 ) 65 (2.4) 0.90 (0.68, 1.19) 68 (2.5) 0.93 (0.68, 1.26) PsO/PsA comparators (13,411 ) 1,052 (7.8) 1.00 332 (2.5) 1.00 309 (2.3) 1.00 AS (529 ) 51 (9.6) 1.36 (0.95, 1.94) 20 (3.8) 2.03 (1.18, 3.50 ) 13 (2.5) 2.15 (1.02, 4.55 ) AS comparators (2,631 ) 180 (6.8) 1.00 48 (1.8) 1.00 32 (1.2) 1.00 SARDs (1,118) 168 (15.0) 1.62 (1.32, 2.00 ) 52 (4.7) 1.74 (1.24, 2.44 ) 49 (4.4) 1.44 (1.00, 2.10 ) SARDs comparators (5,532) 490 (8.9) 1.00 135 (2.4) 1.00 157 (2.8) 1.00 SLE (239 ) 37 (15.5) 1.88 (1.18, 3.00 ) 11 (4.6) 1.67 (0.75, 3.74) &lt;5 0.85 (0.17, 4.29) SLE comparators (1,187 ) 77 (6.5) 1.00 26 (2.2) 1.00 13 (1.1) 1.00 Sjogren’s (96 ) 15 (15.6) 2.07 (0.94, 4.58) &lt;5 * &lt;5 * Sjogren’s comparators (477 ) 35 (7.4) 1.00 14 (2.9) 1.00 15 (3.2) 1.00 Myositis (30 ) 5 (16.7) 3.18 (0.69, 14.55) &lt;5 * &lt;5 * Myositis comparators (150 ) 12 (8.0) 1.00 &lt;5 1.00 7 (4.7) 1.00 Vasculitides (82 ) 25 (30.5) 2.18 (1.17, 4.05 ) 8 (9.8) 1.70 (0.70, 4.16) &lt;5 * Vasculitides comparators (404 ) 64 (15.8) 1.00 21 (5.2) 1.00 16 (4.0) 1.00 Results for systemic sclerosis not presented; sample size too small. *Unable to be calculated (small sample size) Conclusion The risk of severe COVID-19 outcomes is increased in some ARDs, although magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis, and early intervention with available therapies (e.g., oral antivirals) should be prioritized in these groups according to risk. Acknowledgements This work was supported by the Michael Smith Foundation for Health Research (grant COV-2020-1075) and the BC SUPPORT Unit (grant C19-PE-V3). Disclosure of Interests None declared